Why am I suddenly anxious during perimenopause?

You’ve gone through life being the one who had their stuff together, the person everyone else relied on and who knew how to handle a crisis. And while you’ve had moments of anxiousness, you’ve never thought of yourself as having anxiety, until now, and it scares you. 

This doesn’t feel like me

You don’t understand why, all of a sudden, you have lost confidence in your decisions and are now waking up in the middle of the night stewing on them, your brain dragging you into spirals of self-doubt. You don’t know why you are second-guessing the point you’re about to make in a meeting, or making it and then beating yourself up for not landing it as clearly as you wanted to. 

Or maybe your anxiety is showing up in other parts of life, maybe you feel such panic when driving, you’re wondering if you’ll ever be able to drive on the motorway again. You’ve gone from being the one who was capable to a shell of who you used to be, no longer recognising yourself. If you've never struggled with anxiety before, it can be deeply unsettling when it appears seemingly out of nowhere, often during perimenopause. 

For many successful women, this doesn't just mean anxiety; it can mean a crisis of confidence, a loss of identity and trust in themselves. Maybe you’re a doctor who forgets the names of body parts when talking to patients, or a teacher who has gone blank in front of a room of teenagers, or a team lead who has forgotten the name of someone they’ve worked with for years. Whatever your circumstance, the brain fog, forgetfulness and sleep deprivation you’re experiencing can really damage any confidence you once had in your professional capabilities.

Why anxiety can appear during perimenopause

Hormones

During perimenopause, levels of oestrogen and progesterone fluctuate more unpredictably than they have for most of your adult life; you’re on a hormonal rollercoaster. These hormonal changes interact with brain systems involved in mood and stress regulation. For some women, this increases their susceptibility to anxiety, particularly when combined with other factors described below.  

Testosterone may also be playing its part in influencing how motivated, confident and energised you feel. Some women notice a loss of drive, feeling flat, and a sense that their usual spark has disappeared. This can be particularly difficult for women who have spent decades relying on their ambition, focus and determination to succeed. 

Sleep

Next up: sleep. I don’t need to tell you this, but sleep has a massive impact. Some of the reasons for this include that sleep deprivation heightens amygdala activity and that the amygdala plays a key role in threat detection. This means that an email you might normally read and think “that was a bit off”, could turn into “my boss thinks I’m terrible at my job”. 

As well as the amygdala taking its job too seriously, the prefrontal cortex, which normally provides the rational balance to the amygdala, takes its foot off the gas, often leading to increased anxious thoughts and feelings.  

Life load

Perimenopause often arrives at one of the busiest, most high-pressure periods of a woman's life. You’ve got to a point in your career where you’re leading teams, handling large budgets and making decisions that impact departments, this is what you’ve been working towards for years. Maybe you finally feel like you’ve caught up to where you wanted to be after your career being on hold as you prioritised your family. 

Alongside this, that family now includes teenagers or young adults, which can bring angst for them and for you as you renegotiate your roles. And maybe you have ageing parents to add to the mix. All of these pressures are going to ramp up feelings of overwhelm and anxiety. 

How perimenopause impacts work

It‘s this degradation of self-confidence, the associated increase in anxiety, alongside other symptoms, that result in one in ten women who worked during the menopause leaving a job due to their symptoms. There is quite a difference between choosing to leave a job that no longer meets your needs or doesn’t align with your values, and being in a position where you feel like you have no choice but to leave due to menopause symptoms.

Why successful women often find it hardest 

Successful, driven women often struggle the most at this time in life because the anxiety feels so alien to them. For the first time, the usual strategies of hard work, grit, and discipline aren’t working, and effort no longer equals outcomes. 

When we have those moments where words feel like they’ve fallen out of our brains, where we struggle to articulate ourselves properly, we’re our worst critics, beating ourselves up and seeing that as evidence that we can’t do it any more. Maybe we resist that by developing strategies to reassure ourselves, like re-reading simple emails three times, but this draws us into a cycle that never ends well. 

This is a time in life where we need to take some control over our experience, or we’ll risk feeling like things are happening to us, not for us. Seeking support with evidence-based treatment options is an empowering step forward. While we cannot control the hormonal changes of perimenopause, we can influence how we respond to them. Understanding what is happening, improving sleep, addressing anxiety and seeking support can help many women regain confidence. 

We’ve often spent so long prioritising the needs of others, of children, partners, parents and work, and we might have lost sight of ourselves in all of those competing demands.

You might find that you know you want or need to work on reclaiming your identity after years of being mum first, but find it hard to shift your decades-long patterns. This can bring up grief alongside the desire for freedom, and with hypnotherapy, we can honour both, helping you find your way forward rather than being stuck between the feelings that keep you doing all of the 'mum jobs', while also resenting those same responsibilities. Yes, it’s complex, you’re not imagining it.

What helps?

As well as HRT and other medications, there are evidence-based psychological treatments to support anxiety symptoms in perimenopause. A key one is CBT, which is widely shown to help with anxiety and is recommended by the British Menopause Society. Hypnotherapy is also recommended by the British Menopause Society to support with menopause symptoms. Research suggests that adding clinical hypnosis to CBT often improves outcomes compared with CBT alone, showing the power of combining these two treatments to produce more impactful results. 

CBT allows us to identify the times when the amygdala is running the show, telling you that you’re going to lose your job because your boss thinks you’re incompetent. It allows us to work on self-belief and live life, rather than being paralysed by anxious thoughts and feelings. 

Approaches such as Acceptance and Commitment Therapy (ACT) can also be valuable. Rather than trying to eliminate every anxious thought, ACT helps people develop a different relationship with those thoughts so they can continue living according to their values, even when anxiety shows up. 

Hypnotherapy can be particularly helpful because anxiety is not simply a thinking problem. It is also a physiological experience. Many women describe feeling constantly on edge, unable to switch off. Hypnotherapy helps us move into focused relaxation that can reduce physiological arousal, improve sleep and help the brain rehearse new patterns of responding to stress.

What does hypnotherapy for perimenopause anxiety involve?

Many people begin hypnotherapy worried they are going to lose control or be told to "just relax". But really, hypnotherapy for menopause is a collaborative process that combines conversation with focused relaxation and guided imagery.

A typical session might begin by exploring how anxiety is showing up in your life. It is critical to spend some time establishing how it's affecting you so that the hypnosis can be tailored to your circumstances and exactly what you want your life to be. 

Together, we identify the patterns that are keeping anxiety going. This often includes the self-critical inner dialogue that many successful women have developed over years of holding themselves to exceptionally high standards. This is then often ramped up due to the effects of perimenopause. 

During hypnosis itself, you are in control, highly focused and absorbed in the personalised suggestions. People sometimes describe it as a similar feeling to when they're totally absorbed in a book or film. In this state, it can become easier to step back from anxious thinking and begin rehearsing different ways of responding to situations that currently induce anxiety.

Hypnotherapy is not about pretending anxiety does not exist. Together with the ACT and CBT focus, it's about reframing your relationship to your anxious thoughts and feelings, allowing you to do the things that matter to you.

What does this mean for me?

Perimenopause can be an opportunity to reflect, review, and ask ourselves, “What’s working for me?” and “What do I want to keep and what do I want to leave behind?” If you've suddenly become anxious during perimenopause, don’t let it redefine who you are and how you see yourself. 

You are navigating a significant biological and psychological transition, but anxiety during perimenopause is highly treatable. With the right support, many women find they not only regain their confidence, but develop a more sustainable relationship with work, success and themselves.